Archive for the ‘Vaginoplasty revision’ Category

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Sh– Happens

Wednesday, June 30th, 2010

Vaginal Rectal Fistula

A well known but seldom serious post-operative complication of feminizing vaginoplasty is a vaginal-rectal fistula or perforation of the low anterior rectal wall.

We have closed several intraoperatively and all have healed without incident.

Of those noted post-operatively following stent usage, everyone on conservative management also has healed without the need for diverting colostomy.  One patient did seek surgical consultation
in Missouri, her home state, and colostomy was performed and taken down (reversed) 3 months later and she did well.

Our belief is that if you seek surgical consultation, most likely a colostomy will be proposed as this is a time honored and conservative approach.  If you do elect consultation with a surgeon, please
advise and I will cheerfully confer with your chosen specialist.

My bias is… if you are not septic, or in pain, or do not observe any findings to suggest an abscess or intra-abdominal process, you may do very well with the following conservative measures:

1.  Please cleanse any fecal material noted with a gentle vaginal douche as described in your post-operative discharge instructions. To be repeated as needed.

2.  Stop stent usage unless I can personally see you at the office and review dilation technique. Seeing you at the office is recommended.

3.  Have a bathroom scale at home and take your weight every day or so, and chart this.  If you are losing appreciable weight, conservative treatment will no work, as patients in poor protein balance do not heal well.

4.  Stop all solid foods to reduce any stool formation.  Do ingest a minimum of 3 quarts of fluids daily.

5.  You should consider taking 10 cans of Ensure or similar protein shake everyday, throughout the day.  You can consume anything in the fluid family except alcoholic beverages. Ice cream and jello are also encouraged along with beef and chicken consomme.

6.  You will need to be on about a 2500 calorie diet. 

7.  Additionally, visit a nutriontal  store and get protein powder supplement.  Strive for 175 grams to 200 grams of protein daily.   Please advise if you have any kidney malfunction.  Protein granules may be whey or soy based.  Try a GNC store.

8.  Continue on Vitamin C 500 mg 3 times a day.

9.  Take Zinc supplements.  Zinc sulfate 125+ mg  tablets (or 45 to 60 mg of elemental zinc) 3 times a day

10.  Take arginine supplements which may be helpful.  2 to 3 grams, 3 times a day.

11.  The healing process, typically is first absence of stool in the vaginal area, then passage of vaginal gas only and finally no passage of vaginal gas whatsoever.

12.  Once this end point is achieved, wait an additional al 3 to 4 days, and start a low residue diet which does include some solid foods.

13.  Please  call me whenever concerns arise and periodically to update me on your progress.
Harold M. Reed, M.D.

Posted in Feminizing vaginoplasty, Recto-Vaginal Fistula, Vaginal--Rectal Fistula, Vaginoplasty, Vaginoplasty moisture, Vaginoplasty revision, sex change, vaginal stents and dilators | No Comments »

Hair in Vagina and Contracting Girth

Tuesday, May 25th, 2010

Hello everyone,

 My name is Cheryl. I’m new here and exploring options. I transitioned in 2003 and had SRS with Dr xxx in 2004.  I’ve been happy with every aspect of my transition except for losing the “love” of my family and what I consider to be complications immediately upon arriving home following surgery. I called Dr xxx and spoke with him on the phone,  but he was somewhat dismissive and said I just needed to keep dilating and everything would be okay. I’ve been pleased with the aesthetics and I am orgasmic (yay!).

 I continued to dilate, even more than recommended, but the problem never improved. It got to the point where  dilating would cause swelling, which in turn made urinating difficult. I even saw a local urologist who was pleased to take me as a new patient, but he’s unfamiliar with SRS techniques. He found no problem except that I wasn’t able to void my bladder completely. It wasn’t until about a year I made the connection between urinating problems and the sdwelling due to dilation.

 One doesn’t realize just how much they like to pee until they can’t do it well. I eliminated the largest stent from my routine and that seemed to help.   Then some days, the next to largest stent would hurt and cause difficult urination. Eventually, about 24 months post op, I’d given up entirely on dilating. I should mention that at 11 months post op, I met a man, fell in love. He didn’t know my “history” until after we had fallen in love and I told him. I don’t know where I found the courage. That was a tough moment in my life. In any case, he didn’t care, but expressed concerns about “the plumbing already being done.” lol

 A tougher moment in my life was when we discovered, we couldn’t achieve intercourse. Tougher still was the break-up. We tried to remain friends, but it was just too much… mostly for him.

 Anyway, that’s all history. Now, my problem is constriction of the vagina and to make matters worse… my urologist discovered hair growing inside. You can just imagine what this all does for my psyche. Once again, urination is difficult and there’s inflammation around the urethra opening. Why? I don’t know. I’ve been waiting for a week and a half for Dr xxx to return a call.

 It isn’t like you can talk to your neighbor for advice on how they handled these problems. Any thoughts or suggestions would be much appreciated.
Cheryl

Good morning Cheryl,

Thank you for joining our group and your very informative post.

Your report of hair following vaginoplasty and those from Thailand as well is why we have patients get electrolysis before surgery.  “Scraping” in the operating room is not uniformly successful to say the least.

The hair could probably be removed with a few sessions using a vaginal speculum or long beaked nasal speculum and electrolysis. Pulling or teasing with a Kelly clamp might not work permanently and is really not my cup of tea.

You may consider as a conservative approach for vaginal girth enhancement, 2 lateral incisions, avoiding the urethral area, and then yes, you must dilate 6 times a day or more for than 15 minutes until that area is relined with normal
skin.

Glad you are lubricious and orgasmic. Let’s hear what some other savvy members of our group offer.

You will meet many Mr. Right(s) in life, if you are pleasant to be with and can give and receive spiritual love,

Wishing you the best,

Harold M. Reed, M.D.

Posted in MTF, Vaginoplasty, Vaginoplasty revision | No Comments »

MTF Vaginal Tissue Becomes like natal?

Tuesday, May 25th, 2010 
Dr Reed there was a study I read about were in they discussed how the inter wall of the neo vagina changes over time and becomes more like that of a genetic
vagina are you familiar with this study if so do you know were I can find it.

Brenda

Hi Brenda,
Sorry, I do not believe that information is correct.  An aricle to the contrary was presented at the WPATH meeting in Oslo where biopsies were taken of
neo-vaginas versus natal vaginas and the tissue is still very reminiscent of skin.  In fact there is concern  that estrogen creams are not practical for the
neo-vagina as these cells do not have estrogebn receptors.

None-the-less many doctors will prescribe estrogen creams to treat tissue atrophy problems.

All the best as always,

Harold Reed, M.D.

--- >

Posted in Feminizing vaginoplasty, MTF, Vaginoplasty, Vaginoplasty moisture, Vaginoplasty revision | No Comments »

Speak to me of moisture. The drip ?

Sunday, May 23rd, 2010

Dr. Reed,
The more I look into this topic, the less I seem to know. First it was suffer and use products. Then it was sigmoid, more costly but moist. Then it was drip, more work but worth it. Now I read on Dr Reed’s website he is thinking about dropping his latest, the drip, in favor of what, nothing? I know the state-of-the-art advances bit what’s a girl to do? Will someone please help me?
Sharon

Dear Sharon, 

Are you talking about MTF vaginoplasty and when you say “the drip.”    Please explain. Please cite some references or web-site addresses where this term is mentioned.

Posted in Feminizing vaginoplasty, Vaginoplasty, Vaginoplasty revision, Vaginoplaty moisture, sex change | No Comments »

Anticipating Vaginoplasty, many questions for Dr. Reed

Sunday, April 4th, 2010

April 2, 2010

Good morning Joleene,

Sounds like you are well on your way.

Taking your thoughtful questions in the order posed.

Do you have an updated FAQ? I have the FAQ from a year ago, but if you have a more recently updated FAQ I would very much appreciate seeing it.

Attached.

Is your clinic outpatient certified?

Quad A, and also registered with the Florida Board of Medicine.

Who regulates your clinic?

Regulations of of Quad A (The American Association for Accreditation of Ambulatory Surgery Facilities, Inc.
http://www.aaaasf.org/ and Florida Board of Medicine. We were built to HRS specifications.  The inspectors were all over the place checking out every physical aspect, fire walls, air exchanges per hour, filters, you name it.

Who does the anesthesia?

Anesthesia is provided usually by a licensed CRNA (“Uncle Bob”) who has hospital privileges, and has been with us for
over 20 years. Anne our office manager and assistant has been with me for 28 years.

I understand that if I do need to go to a hospital due to complications after the surgery that you would accompany me and handle the situation. Is this still correct?

Yes..

Are you allowed to perform any needed corrective surgeries in that hospital?  Life threatening surgery could be performed, but cosmetic revisions are reverted to our facility. So far, the reasons for transfer have included an occasional need for transfusion and one patient I had a psychotic break.

How often do you visit the hotel that I will be staying at?

Daily and more often if needed. It is an easy 8 minute drive away from our office.

Does your clinic staff visit the hotel as well, and how often do they visit?

No, the staff does not visit the hotel. The RN for your overnight stay and I do bring you to the hotel the morning after surgery. Christina, the amiable hotel manager will show you an unusual amount of attention. We also recommend
a friend or loved one be with you for a few days. In that you live in Boca, chances are you could return home by or around the 4th post-operative day.

I understand that touch ups are done at no extra charge 3 months after the surgery.

After complete wound healing, usually 3 the 4 months after surgery. That is true, but if you need a general anesthesia allow an additional 600 to cover the costs of anesthesia.

Is this something you recommend even if what needs to be touched up is minor?

Yes, I am all for touch ups, because I want you to have an excellent result, that a patient from any other office would be envious of.

I intend on getting a loan to have my surgery completed before the end of this year.  Is there any specific source that you would recommend to get the medical loan?

For a line of Medi-credit, please try

Reliance Finance Company, LLC

http://www.reliancemedicalfinance.com/

1-888-502-8020

or

Chase Health Advance, USA only
www.unicornfinancial .com

or

Medicard Finance, Canada only.

http://www.medicard.com/

or

www.carecredit.com
automated phone application # is (800) 365-8295

If a service charge is imposed on the doctor, often 3 to 5% that fee which is taken out of my check is passed back to
you. Ask, as not all loan companies impose a service fee.

If you believe I am the doctor for you, please initiate a consultation with our office by sending us your name, address, and phone number in an envelope along with a check for 250 and you will receive a call ASAP. We’ll have a lot to talk about.

There is a lot of information we need to put out to you, as well as answer your all questions and concerns. This fee provides for followup discussion and covers your first visit at the office excluding laboratory work.

Anticipate we will show you every courtesy.

With kindest regards,

Harold M. Reed, M.D.
305-865-2000
1111 Kane Concourse, Suite # 311
Bay Harbor Islands, Fl 33154-2041

At 10:30 PM 3/31/2010, you wrote:
Hello Dr. Reed,

We spoke a little less than a year ago, and my situation since then has changed drastically. I am now intending on having my vaginoplasty completed before the end of this year. I am still considering coming to you for my surgery due to how close you are (I live in Boca Raton) as well as thanks to how much you charge. Some really quick basic information:
I am 22 years old.
I have been on hormones since August 21st, 2008.
I have been full time female since December 1st, 2008.
I have legal proof of being full time female (name change court order) since February 11th, 2009.
I am slim, and while I may not be in the best physical condition I am actively working on that now and by the time I have my surgery I expect to be physically fit.
I have never had any surgery before in my life.

Please answer the following questions as they will have a drastic weight in my decision to come to you for my surgery or another doctor:

Do you have an updated FAQ? I have the FAQ from a year ago, but if you have a more recently updated FAQ I would very much appreciate seeing it.
Is your clinic outpatient certified?
Who regulates your clinic?
Who does the anesthesia?
I understand that if I do need to go to a hospital due to complications after the surgery that you would accompany me and handle the situation. Is this still correct?
Are you allowed to perform any needed corrective surgeries in that hospital?
How often do you visit the hotel that I will be staying at?
Does your clinic staff visit the hotel as well, and how often do they visit?
I understand that touch ups are done at no extra charge 3 months after the surgery. Is this something you recommend even if what needs to be touched up is minor?
I intend on getting a loan to have my surgery completed before the end of this year. Is there any specific source that you would recommend to get the medical loan?

Thank you for your assistance, and I look forward to eventually meeting you in person for my consultation.

Joleene

Posted in Feminizing vaginoplasty, MTF, Vaginoplasty, Vaginoplasty revision, sex change | No Comments »

You or the Thailand Doctor

Sunday, April 4th, 2010

Dear Dr. Reed,

I wrote to you awhile back regarding SRS…..You mentioned a “Grant subsidary” and I was wondering if that is still available. I don’t know if you will remember me but I’ve contacted you several times…..the last time I mentioned contemplating having the surgery with a Dr. _ _  in Thailand. I am still greatly contemplating whether or not I should go to him or go to you. My main issue is being able to afford the SRS. I get SSI,about $800 a month indefinitely. If there is a way to have it done with you I would much prefer it. My reasons for choosing Dr.Pichet at the moment are based on the fact that he only charges $6500 USD for the SRS. The only thing at the moment that is slowing my process to go to Thailand is my great fear of flying.  I don’t like the feeling of taking a huge risk with this….I want to be sure I will be alive after the SRS and that my neo vagina will be orgasmic and functioning properly. Not that I don’t really trust him,it’s just that my gut instinct tells me I should wait and have my SRS with you Dr.Reed. It’s already April and I have’nt wired my full amount to Dr. (so and so)  yet because of my contemplating.

If there is a way to get my SRS from you this year,I would….I will definitely refund my deposit from the Dr.  and much rather go with you if it feels right. One because you are closer by and I would much prefer not having to fly such a great distance. Two there is’nt much of communication barrier because you are also American.Three I’ll be closer to relatives ( I have family who live in Orlando ).

Anyways I am venting you my feelings. I’ve only got around $4 k to my name at the moment. Wiring all this money overseas also puts a huge stressor on my part.

I spoke to you on the phone once before…. Dr.Reed I need your help and advice.

Sincerely,

Irela

April 4, 2010

Good morning Irela,

Thank you ever so much for your heartfelt letter and your candor.

You will own many cars in a lifetime, possibly a few homes or condos, but a cosmetically and functioning below the waist result, you should only have to invest in once.   And in all honesty, it is a lot less expensive than any of the above, regardless of where your surgery is done.

When you are given a discount, our working staff continues to work at full wages.  All our operating expenses remain the same.   There are no clocks in our operating room and no price tags on our patients.  Also please be advised you will need some contingency funds to cover the possibility of a return visit for a touch up or continuity of care with a local doctor.

Patients having had surgery abroad and coming to us for a revision is not at all unusual.  Our policy for our established patients is not to charge unless a general anesthetic is required which is 600.  A lot less expensive than a plane fare back to Thailand.

Please don’t read that book, “Europe on 8 Dollars a Day” and think for 56 dollars you can vacation in Europe for a week.  There are always out of pocket expenses which you need to factor into your cost, such as travel for you and perhaps a companion or loved one, food, medications, some medical supplies and stents, hotel lodging for about 8 days, although if you have a friend in Miami you could stay there and save about 4 days.

We will work with you to make your dreams come true, and we will offer a vastly discounted fee, for a substantial deposit, good for 1 year.  Please also recognize that a deposit up to 50% of the negotiated price is non refundable.

This past week I the honor of being asked to write an article for ?Sex reassignment surgery:  Male to Female? for Seminars in Plastic Surgery edition on: “Aesthetic and Functional Genital and Perineal Surgery:  Male and Female”.

This May, I will be delivering a talk to the Aqua Transsexual Society in North Miami.  My patient Jessica had appeared on Larry King Live last year.

If you have not submitted a 250 consultation fee to our office, really that is step number one as we need to be sure you are a surgical candidate.  Review once again our attached letter.

Please call Anna in the office on Monday as she is the brains behind pa and the maker of deals. 

Let’s hope we can make it happen for you,

Have a blessed Easter Sunday,

Harold M. Reed, M.D.

305-865-2000

Posted in Feminizing vaginoplasty, MTF, Vaginoplasty, Vaginoplasty revision | No Comments »

Desirability of Touch up after “one stage” MTF vaginoplasty

Tuesday, January 26th, 2010

Good morning Kim,

Like the stewardesses say, “be careful accessing the overhead racks as articles tend to shift in flight.” I have never seen a class A result either from this office or from any other doctor, where after a few months something could be done to improve the appearance. May be a noticeable scar, or small separation that healed with a scar, or a urethral opening up too high or an elevated posterior lip, or a clitoris that is too prominent or could use more hooding, or labia majora that simply do not look youthful.

I strive to have all my patients be a visual “turn on.” Yes, I find the female genitalia very attractive and feel if someone is paying big bucks and entrusting their care to me, they deserve something really extraordinary.

We only want walking positive advertisements. For that reason, we do touch ups at no charge under local with IV sedation, with the understanding if the patient is overly anxious, or has a history of drug tolerance, or needs a fair amount of work to be done, they do have to pay for the services of anesthetist which never exceeds 600 and could be less. Everything else is on me and don’t forget to bring that ring pillow back again. Sitting on your incision line is not good for wound healing!

Sincerely,

Harold M. Reed, M.D.
305-865-2000

Posted in Feminizing vaginoplasty, MTF, Vaginoplasty, Vaginoplasty revision | No Comments »

Another MTF Vaginoplasty revision requested

Sunday, January 24th, 2010

Dear Dr. Reed,

You have my photographs.  Hope you can make me as pretty as what I see on your web-site   srsMiami.com

April,     PS:  here is Camilla’s enthusiastic letter.

Dearest Dr. Reed, First of all, I will d?like to say THANK YOU VERY MUCH for your wonderful revision labiaplasty you did on me. I?M VERY HAPPY! Let me say hello and thanks to you secretary Anne, as well, such kindly and lovely. I had all of kind of attentions and care about the staff, and lots of care from you. I consider to advice all the folks need procedures about any kind of ?sexual gender problems? to go to Dr. Reed. He’s definetelly, is the best of surgeon and as good person. Thank you forever. Camilla

September 23, 2008

Good afternoon April,

Thank you for your excellent medical photographs.  Very helpful.

Yes, I agree the labia and clitoral hood are the most notable areas that need revision.  I do believe you will receive a result that will make you smile at last, no more double-take looks.

Last week we did a similar case, perhaps not as exaggerated as yours, and she was very pleased.  Here is a “thank you post” from our http://srsmiami.com/blog/

Thanks for Vaginoplasty Revision

September 21st, 2008

 

  1. Camilla F. | pinko@pallino.it | srsmiami.com | IP: 87.18.47.195 Dearest Dr. Reed, First of all, I will d?like to say THANK YOU VERY MUCH for your wonderful revision labiaplasty you did on me. I?M VERY HAPPY! Let me say hello and thanks to you secretary Anne, as well, such kindly and lovely. I had all of kind of attentions and care about the staff, and lots of care from you. I consider to advice all the folks need procedures about any kind of ?sexual gender problems? to go to Dr. Reed. He?s definetelly, is the best of surgeon and as good person. Thank you forever. Camilla

Posted in Feminizing vaginoplasty, MTF, Vaginoplasty, Vaginoplasty revision, sex change | No Comments »

MTF Vaginoplasty revision

Sunday, January 24th, 2010

Dear Dr. Reed I recently emailed you advising that I had SRS MTF sutgery. I asked about vaginal deepening procedures and labiaplasty. You wanted me to come in to your office. I will be in the Miami SOuth Beach area 02-28-2010 until 03-04-2010 iwanted to know if i can come into your office on a friday or monday .  Please email me back or call to verify appt dt and time !!!!!!
How you heard about us: annelawrence.com

January 24, 2010

Dear Nicole,

What a pleasant surprise to hear from you.

Preesently on retreat in the Carolinas followed by 2 fully booked weeks in Miami. But do call the office on Monday February 1, 2010 and schedule in.

Anne our amiable office manager should be very helpful.

With every best wish,

Harold M. Reed, M.D.,
305-865-2000

Posted in Feminizing vaginoplasty, MTF, Vaginoplasty, Vaginoplasty revision | No Comments »

When will a scrotal graft be necessary?

Sunday, January 10th, 2010

Re: When will a scrotal graft be necessary, Nessie

Hi Nessie,

The use of a scrotal graft is really necessary for any one who is seeking adequate depth for penetrating sex. For the past year we counsel the patient pre-op and do it at no extra charge, because we want you to be a happy. You never know when Mr. Right comes along.

Very rarely when a patient says do not do it, if they are confirmed asexual or lot older, and it is desirable to save 45 minutes of operating time, that step will be eliminated in the interest of patient safety. Unless someone has a stretched penile shaft skin length of 7 inches, we heartily recommend that
scrotal graft extension be done.

In conjunction with this we also recommend electrolysis starting 3 months before. We have seen hair grow back on patients who have last moment epilation in the operating room. Even if successful the trauma to the scrotal tissue may reduce ideal graft take.

The scrotum will stretch almost like a latex glove, so once the graft is above the level of the pelvic floor, you can build upon our depth to suit, providing you embark upon early and dedicated stent usage, until again Mr. Right comes along.

If dilation is painful initially, this is quite normal. Then consider EMLA cream or lidocaine jelly 2%. Please do not procrastinate. Your doctor will show you, using the palm of your hand, how hard you can push safely. Even if you just gain an 1/8″ every week, it adds up.

Harold M. Reed, M.D.
305-865-200

Posted in Feminizing vaginoplasty, MTF, Vaginoplasty, Vaginoplasty revision, sex change | No Comments »

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